Treatment of skin and soft tissue defect in the hallex with flaps / 中华整形外科杂志

<p><b>OBJECTIVE</b>To summarize the therapeutic effect of 5 kinds of flaps for the treatment of skin and soft tissue defect in the hallex.</p><p><b>METHODS</b>From Jan. 2008 to Jun. 2013, 24 cases with skin and soft tissue defects in the hallex were treated with 5 kinds of reversed flaps, including medial foot dorsal neurocutaneous flaps, medial foot neurocutaneous flaps, lateral tarsal flaps, anterior malleous flaps, medial cross leg and saphenous nerve flaps. The defects size ranged from 3 cm x 2 cm to 5 cm x 3 cm, with the flap size from 3. 5 cm x 2. 5 cm to 5. 5 cm x 4. 0 cm.</p><p><b>RESULTS</b>Partial superficial necroisis happened at the distal end of one foot dorsal medial neurocutaneous flap. One third flap necrosis occurred in 1 foot medial neurocutaneous flap due to too tight suture at flap pedicle and resulted thrombosis. All the other 23 flaps survived completely. 15 cases were followed up for 3-36 months with normal walking function and satisfactory appearance. Among the 8 cases with nerve anastomosis, 4 cases were followed up with 2-point discrimination distance of 8-11 mm. the flaps without nerve anastomosis also had protective sense due to nerve ingrowth.</p><p><b>CONCLUSIONS</b>Skin and soft tissue defects in the hallex can be treated with different appropriate flaps. The hallex length can be reserved with satisfactory function and appearance.</p>

[Early clinical outcomes of fixed-bearing versus mobile-bearing total knee arthroplasty].

OBJECTIVE: To compare the early clinical outcomes of primary total knee arthroplasty by a fixed-bearing versus mobile-bearing prosthesis. METHODS: A total of 80 patients with osteoarthritis at our hospital from January 2008 to October 2008 were sequentially and randomly assigned into Group A (fixed-bearing prosthesis) (40 knees) and Group B (mobile-bearing prosthesis) (40 knees). And the data of the range of motion (ROM), Knee Society Score (KSS) and Western Ontario MacMaster (WOMAC) were collected at pre-operation and 6, 12 and 24 months post-operation respectively. RESULTS: The P values were as follows: KSS: 0.754, 0.802, 0.561, 0.764; HSS (Hospital for Special Surgery): 0.737, 0.361, 0.254, 0.330; WOMAC (Western Ontario and McMaster Universities) osteoarthritis index: 0.976, 0.557, 0.946, 0.818; ROM follow-up: 0.519, 0.646, 0.175, 0.276. No significant differences were found in clinical outcomes between two groups. CONCLUSION: The fixed-bearing and mobile-bearing prostheses show no difference in clinical outcomes.

[Comparison of anterior knee pain between fixed-bearing prosthesis and mobile-bearing prosthesis after total knee arthroplasty].

OBJECTIVE: To compare the difference of anterior knee pain between mobile-bearing prosthesis and fixed-hearing prosthesis after total knee arthroplasty (TKA). METHODS: Between January 2008 and October 2008, 72 patients with osteoarthritis were treated with primary TKA. All patients were randomly divided into fixed-bearing prosthesis group (n = 37) and mobile-bearing prosthesis group (n = 35). In fixed-bearing prosthesis group, there were 8 males and 29 females with an average age of 69.6 years (range, 57-76 years), weighing from 55 to 92 kg (mean, 66.7 kg); the locations were the left knee in 20 cases and the right knee in 17 cases; the body mass index (BMI) ranged from 17.6 to 37.3 (mean, 26.2); the disease duration was 3-22 years; the Knee Society Score (KSS) knee score, function score, patellar score, and pain score were 29.4 +/- 15.3, 33.4 +/- 16.8, 7.2 +/- 2.5, and 2.5 +/- 2.2 respectively; and the Insall-Salvati (I-S) index was 1.6 +/- 0.3. In mobile-bearing prosthesis group, there were 9 males and 26 females with an average age of 68.2 years (range, 58-73 years), weighing from 50 to 86 kg (mean, 67.9 kg); the locations were the left knee in 30 cases and the right knee in 5 cases; the BMI ranged from 18.4 to 34.4 (mean, 25.6); the disease duration was 6-18 years; the KSS knee score, function score, patellar score, and pain score were 30.9 +/- 14.7, 31.4 +/- 14.4, 6.8 +/- 3.1, and 2.0 +/- 2.3, respectively; and the I-S index was 1.6 +/- 0.2. There was no significant difference in general data between 2 groups (P > 0.05). RESULTS: All incisions healed by first intention; no deep vein thrombosis of lower limbs or pulmonary embolism occurred. All patients were followed up 12-16 months. In mobile-bearing prosthesis group, knee infection occurred in 1 case, dislocation of the knee in 1 case, and clicking of the knee in 3 cases; in fixed-bearing prosthesis group, clicking of the knee occurred in 1 case. There was no significant difference in KSS knee score, function score, patellar score, or pain score between 2 groups (P < 0.05) at last follow-up; and there was no significant difference in congruence angle, lateral patellofemoral angle, patellar tilt angle, lateral patellar displacement, patellar displacement, or I-S index between 2 groups at last follow-up (P > 0.05). Anterior knee pain occurred in 7 cases (18.9%) of the fixed-bearing prosthesis group and in 5 cases (14.3%) of the mobile-bearing prosthesis group, showing no significant difference (chi2 = 0.227, P = 0.634). There were significant differences in KSS knee score, function score, patellar score, and I-S index between patients with anterior knee pain and patients without anterior knee pain (P < 0.05). CONCLUSION: Fixed-bearing prosthesis and mobile-bearing prosthesis have the same short-term effectiveness and the incidence of anterior knee pain.